Improving Health Services Through Empowered Community Health Governance Structures in Tanzania

Abstract

Decentralization policy in Tanzania has facilitated the formation of local health governance structures to ensure greater participation of communities in the management of health services. Using different methods, such as a review of existing literature, interviews, and focus group discussions with various stakeholders at the central government level as well as in fourteen councils, this paper analyzes and discusses limitations to the proper functioning of local health governance structures. The study reveals that service boards and facility governing-committees are relevant health governance structures in providing checks for the accountability of health managers and providers, forging linkages between the technical-medical professionals and communities, and also in ensuring communities' participation in improving health service provision. Unfortunately, the performance of these structures is weak in most cases, which ultimately compromises community participation and ownership. Capacity strengthening with the aim of improving the understanding of their roles and functions, enhancing their planning and budgeting skills, and their understanding of hierarchies and division of roles and responsibilities among governance structures, are among the major recommendations from this study. Keywords: health sector reforms, community participation, health governance structures, service boards, facility-governing committees, health services